April 06, 2021
Area(s) of Interest:
Payor Issues and Reimbursement
The Centers for Medicare & Medicaid Services (CMS) recently announced it had begun recouping COVID-19 accelerated and advance payments on March 30, 2021. This marks one year from the date the agency expanded its accelerated and advance payment program for participating Medicare providers and suppliers to lessen the financial hardships of the COVID-19 pandemic.
Accelerated and advance Medicare payments provide emergency funding and address cash flow issues based on historical payments when there is disruption in claims submission and/or claims processing. These expedited payments are typically offered in natural disasters to accelerate cash flow to the impacted health care providers and suppliers. CMS in March 2020 expanded eligibility for the program to all Medicare providers and suppliers throughout the country.
Providers who received a COVID-19 accelerated or advance payment – and have not made full repayment – will begin to see any outstanding balance recouped from payments due to them from their Medicare claims. The recoupment will begin on the one-year anniversary of when they received their first payment.
According to CMS, the recoupments will take the form of a 25% withhold of Medicare payments due to the provider. The 25% withhold will continue for 11 months, at which point the withhold will increase to 50% for 6 months.
CMS also reminds providers that if the advance payments are not fully paid after this 29 month period (comprised of the initial 12 months where no amount is due, 11 months subject to the 25% withhold, and 6 months subject to the 50% withhold), then the provider’s Medicare Administrative Contractor—Noridian in California—will issue a demand letter for full repayment of any remaining balance. If full payment is not received 30 days after issuance of the demand letter, interest will accrue at a rate of 4% from the date the demand letter was issued.
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